The effect of nasopharyngoscopic biofeedback in patients with cleft palate and velopharyngeal dysfunction

Objective To evaluate the immediate, long-term, and carry-over effects of nasopharyngoscopic biofeedback therapy in patients with cleft palate who exhibit velopharyngeal dysfunction (VPD). Design Pre- versus posttreatment and follow-up comparisons. Setting Cleft palate center of the Heidelberg University Hospital, Heidelberg, Germany. Subjects Eleven patients with VPD who had received conventional speech therapy without showing significant improvement. Interventions A four-stage feedback procedure. The patients watched and evaluated their velopharyngeal (VP) valving during speech by an endoscopic image displayed on a video monitor. Two feedback sessions took place for every target sound. Main Outcome Measures Mean occurrence of VP closure during speech sound production on different linguistic levels. Patients’ self-perception was assessed by a questionnaire and speech diary. Results Significant improvement and stability of VP closure was noted. Mean occurrence of VP closure was 5% before therapy, 91% after two biofeedback sessions, and 86% in the follow-up after 6 months. Velopharyngeal dysfunction associated with compensatory articulation proved to be equally well trained as VPD on sounds with good articulatory placement. No significant difference was observed in the degree of improvement between phoneme-specific VPD and generalized VPD. The transfer to the level of words and sentences was successful and showed significant stability. The stability of VP closure for vowels was less than the stability for fricatives and stop sounds. Patients gained improved auditory and kinesthetic self-perception of their articulation. Conclusions Nasopharyngoscopic biofeedback therapy proves to be a quick and effective method to change VPD. It shows stable results and carry-over effects.